Bottom Line:
The combined proportion of any resistance decreased from 23.3% in 2004 to 14.3% in 2008, and that of MDR-TB from 11.5% to 2.4%.The proportion of TB patients with drug-resistant TB in Eastern Taiwan remains substantial.However, an effective TB control program has successfully driven the proportion of drug resistance among TB patients downward.

Background: The Taiwan health authority recently launched several tuberculosis (TB) control interventions, which may have an impact on the epidemic of drug-resistant TB. We conducted a population-based antituberculosis drug resistance surveillance program in Eastern Taiwan to measure the proportions of notified TB patients with anti-TB drug resistance and the trend from 2004 to 2008.

Methods and findings: All culture-positive TB patients were enrolled. Drug susceptibility testing results of the first isolate of each TB patient in each treatment course were analyzed. In total, 2688 patients were included, of which 2176 (81.0%) were new TB cases and 512 (19.0%) were previously treated cases. Among the 2176 new TB cases, 97 (4.5%) were retreated after the first episode of TB treatment within the study period. The proportion of new patients with any resistance, isoniazid resistance but not multidrug-resistant TB (resistant to at least isoniazid and rifampin, MDR-TB), and MDR-TB was 16.4%, 7.5%, and 4.0%, respectively, and that among previously treated cases was 30.9%, 7.9%, and 17.6%, respectively. The combined proportion of any resistance decreased from 23.3% in 2004 to 14.3% in 2008, and that of MDR-TB from 11.5% to 2.4%.

Conclusions: The proportion of TB patients with drug-resistant TB in Eastern Taiwan remains substantial. However, an effective TB control program has successfully driven the proportion of drug resistance among TB patients downward.

pone-0031531-g003: Decline of the drug resistance among previously treated tuberculosis patients and the calendar of introduction of new TB control interventions in Eastern Taiwan, 2004–2008.

Mentions:
The downward trend of resistance among previously treated patients was more prominent than that among new cases. Figure 2 shows that the proportion of MDR-TB among previously treated cases was 25.9% in 2004, which decreased consistently to 5.0% in 2008 with a cumulative reduction of 80.7%. The respective figures for that among new patients were 4.9%, 2.0% and 59.2%. Similar findings were observed for other first-line drugs except SM. Figure 3 shows the trends in the proportions of drug resistance among previously treated patients and the calendar for introducing new TB control interventions in Eastern Taiwan.

pone-0031531-g003: Decline of the drug resistance among previously treated tuberculosis patients and the calendar of introduction of new TB control interventions in Eastern Taiwan, 2004–2008.

Mentions:
The downward trend of resistance among previously treated patients was more prominent than that among new cases. Figure 2 shows that the proportion of MDR-TB among previously treated cases was 25.9% in 2004, which decreased consistently to 5.0% in 2008 with a cumulative reduction of 80.7%. The respective figures for that among new patients were 4.9%, 2.0% and 59.2%. Similar findings were observed for other first-line drugs except SM. Figure 3 shows the trends in the proportions of drug resistance among previously treated patients and the calendar for introducing new TB control interventions in Eastern Taiwan.

Bottom Line:
The combined proportion of any resistance decreased from 23.3% in 2004 to 14.3% in 2008, and that of MDR-TB from 11.5% to 2.4%.The proportion of TB patients with drug-resistant TB in Eastern Taiwan remains substantial.However, an effective TB control program has successfully driven the proportion of drug resistance among TB patients downward.

Background: The Taiwan health authority recently launched several tuberculosis (TB) control interventions, which may have an impact on the epidemic of drug-resistant TB. We conducted a population-based antituberculosis drug resistance surveillance program in Eastern Taiwan to measure the proportions of notified TB patients with anti-TB drug resistance and the trend from 2004 to 2008.

Methods and findings: All culture-positive TB patients were enrolled. Drug susceptibility testing results of the first isolate of each TB patient in each treatment course were analyzed. In total, 2688 patients were included, of which 2176 (81.0%) were new TB cases and 512 (19.0%) were previously treated cases. Among the 2176 new TB cases, 97 (4.5%) were retreated after the first episode of TB treatment within the study period. The proportion of new patients with any resistance, isoniazid resistance but not multidrug-resistant TB (resistant to at least isoniazid and rifampin, MDR-TB), and MDR-TB was 16.4%, 7.5%, and 4.0%, respectively, and that among previously treated cases was 30.9%, 7.9%, and 17.6%, respectively. The combined proportion of any resistance decreased from 23.3% in 2004 to 14.3% in 2008, and that of MDR-TB from 11.5% to 2.4%.

Conclusions: The proportion of TB patients with drug-resistant TB in Eastern Taiwan remains substantial. However, an effective TB control program has successfully driven the proportion of drug resistance among TB patients downward.